Evaluating the Implementation of a Pilot Quality Improvement Program to Support Appropriate Antimicrobial Prescribing in General Practice.

Ruby Biezen,Kirsty Buising,Karin Thursky,Rachael Ball,Tim Monaghan,Ron Cheah,Malcolm Clark,Jo-Anne Manski-Nankervis

doi:10.3390/antibiotics10070867

Abstract

Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs’ decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a “whole of practice” approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.

Highlights

There is global concern about inappropriate prescribing of antimicrobials as this can drive antimicrobial resistance and adverse events including allergic reactions, side-effects and altered microbiome without clinical benefit [1,2,3,4]
We have demonstrated the acceptability of a pilot audit and feedback program called the General Practice National Antimicrobial Prescribing Survey (GP NAPS) which provided feedback to general practitioners’ (GPs) around appropriateness of antimicrobial prescriptions and compliance with guidelines [13]
While the GP NAPS audit data showed an overall decrease in the number of antibiotic prescribed, a slight overall percentage increase in the number of indications documented in the electronic medical records (EMRs), and an overall percentage decrease in the indication entered in the audit pop up tool, we cannot determine the significance of these results due to the small sample size

Summary

Introduction

There is global concern about inappropriate prescribing of antimicrobials as this can drive antimicrobial resistance and adverse events including allergic reactions, side-effects and altered microbiome without clinical benefit [1,2,3,4] This has been highlighted as an issue in Australia, which is in the top 25% of countries with the highest rates of antibiotic prescribing in the community compared with other European countries and Canada [5]. Despite these high volumes of antimicrobial prescribing in the community [5], there are no current models for an effective antimicrobial stewardship (AMS) program in Australian general practice to help optimise appropriate prescribing. We identified that improved documentation of the reason for prescription in the EMR and point-of-care access to guidelines [14] would facilitate the use of clinical decision support tools and enable automation of a clinically meaningful passive audit process

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